Original research: Postpartum testing rates among women with a history of gestational diabetes—Systematic review

Carson, Michael P.; Frank, Matthew I.; Keely, Erin

doi:10.1016/j.pcd.2013.04.007

Cited by 98 publications

(94 citation statements)

References 67 publications

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“…The short duration of follow-up may have underestimated the extent to which screening occurs in the obstetrics or primary care settings, however a recent systematic review suggested that most women who do complete postpartum testing after GDM do so within the first 3 months of delivery. 25 Though there were few differences in the characteristics of those for whom we had follow-up information at a 3-month study visit, our findings may reflect the patterns of a population more adherent to medical care. Finally, our reliance on documentation in the medical record and subject confirmation of the diagnosis of GDM or HDP could have led to a more adherent group of providers and patients.…”

Section: Discussionmentioning

confidence: 67%

“…25 The requirement that women attend a follow-up study visit led to a somewhat selected population, however completion of cholesterol screening for CVD risk factor stratification was lower than the 63.2% overall rate in the United States among 18-44 year olds as measured by Behavioral Risk Factor Surveillance System. 34 Like earlier studies, we identified characteristics of the women associated with completion of postpartum surveillance and screening tests after GDM which reflect with social determinants of health, specifically having private health insurance and greater education.…”

Section: Discussionmentioning

confidence: 99%

“…19 Though follow-up glucose testing is recommended after GDM for risk stratification, ongoing surveillance, lifestyle counseling, and in some cases medical treatment, 20 observational studies consistently show low rates of screening after delivery. [21][22][23][24][25] Less is known about followup care for women after HDP, though evidence suggests gaps in CVD risk screening by both the obstetrician/gynecologist (ObGyn) and the primary care provider (PCP). 26 The result may be missed opportunities, limiting the potential effectiveness of preventive healthcare for this group of women.…”

Section: Introductionmentioning

confidence: 99%

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Postpartum Healthcare After Gestational Diabetes and Hypertension

Ehrenthal

Maiden

Rogers

et al. 2014

Journal of Women's Health

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Background: Gestational diabetes and hypertensive disorders of pregnancy identify women with an elevated lifetime risk of diabetes and cardiovascular disease. Methods: Prospective cohort of women recruited from the postpartum service of a large community-based academic obstetrical hospital after delivery of a pregnancy complicated by gestational diabetes (GDM) or a hypertensive disorder of pregnancy (HDP). Interviews were conducted, and validated surveys completed, before hospital discharge and again 3 months postpartum.Results: The study sample included 249 women: 111 with GDM, 127 with HDP, and 11 with both. Most, 230 (92.4%) had a PCP prior to pregnancy and 97 (39.0%) reported an office visit with their PCP during the prenatal period. Of the 176 (70.7%) participants who attended the 3-month study visit, 169 (96.0%) women with either diagnosis reported they had attended their 6-week postpartum visit. By the 3-month study visit, 51 (57.9%) women with GDM had completed follow-up glucose testing; 93 (97.9%) with HDP had follow-up blood pressure testing; and 101 (57.4%) with either diagnosis recalled ever having completed lipid screening. Women least likely to complete screening tests were those who had no college education, less than a high school level of health literacy, and who were not privately insured. Conclusion: There are important opportunities to improve postpartum testing for diabetes and CVD risk factor assessment. Most women were connected to primary care suggesting a ''hand-off'' to a primary care physician after pregnancy is feasible. More robust strategies may be needed to improve follow-up care for women with less education, lower health literacy, and those without private health insurance.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postpartum Healthcare After Gestational Diabetes and Hypertension

Ehrenthal

Maiden

Rogers

et al. 2014

Journal of Women's Health

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“…Women with GDM are at increased risk of developing type 2 diabetes (4) or pre-diabetes in the follow-up, and should have a postpartum evaluation in order to disclose persistent alterations of glucose metabolism, either by performing an oral glucose tolerance test (OGTT) or fasting plasma glucose (5,6). Rates of return after postpartum vary across studies, ranging from as low as 3.4% after routine care advice in the three month postpartum period, to a rate as high as 92.6% with active reminder strategies, as described in a recent systematic review including 54 studies (7).…”

Section: Introductionmentioning

confidence: 99%

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Weinert

Mastella

Oppermann

et al. 2014

Arq Bras Endocrinol Metab

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Objectives:The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Subjects and methods:Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n = 14), OGTT (n = 93) or random glucose (n = 1). Return was associated with lower parity rate (2 vs. 3, p < 0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p = 0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk -RR 2.41, p = 0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p = 0.045), insulin use during pregnancy (RR 2.37, p = 0.014), and cesarean section (RR 2.61, p = 0.015). Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia. Resultados: Das 209 mulheres arroladas na gestação, 108 (51,7%) foram avaliadas após o parto: 14 com glicemia de jejum, 93 com o TOTG e uma com glicemia ao acaso. O retorno para reavaliação foi associado com menor paridade (2 vs. 3, p < 0,001) e com glicemia de 2-h mais elevada no TOTG diagnóstico (165 vs. 155 mg/dL, p = 0,034). Diabetes foi diagnosticado em quatro mulheres (3,7%) e pré-diabetes em 22 (20,4%). Análise multivariada evidenciou que a história familiar de diabetes (risco relativo -RR 2,41, p = 0,050), a glicemia de 2 horas no TOTG da gestação (RR 1,01, p = 0,045), o uso de insulina na gestação (RR 2,37, p = 0,014) e a taxa de cesariana (RR 2,61, p = 0,015) foram os fatores associados à persistência da hiperglicemia. Conclusões: O retorno para reavaliação foi baixo, embora as alterações glicêmicas tenham sido frequentes. Como não houve fatores que indiquem quais mulheres retornarão, estratégias para aumentar a adesão são necessárias, especialmente quando há história familiar ou o DMG foi mais grave. Arq Bras Endocrinol Metab. 2014;58(2):197-204 Descritores Diabetes gestacional; reavaliação pós-parto; DMG; diabetes tipo 2; teste oral de tolerância à glicose ¹ Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul

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“…Reasons for inconsistencies in testing include poor knowledge of or inconsistencies in guidelines, limited documentation of GDM in pregnancy, and inconvenience for the patients. The current recommendation is testing between 6-12 weeks postpartum with either a fasting blood glucose (FBG) or the 75-gram Oral Glucose Tolerance Test (OGTT) which takes approximately 2.5 hours to complete [16]. In terms of identifying women with postpartum dysglycemia, researchers have begun examining if a more convenient testing approach would provide comparable results to the OGTT.…”

Section: Assessment Of Glucose Tolerancementioning

confidence: 99%

Postpartum Care of Women Affected by Diabetes: A Review of Current Trends

Shelton¹

2015

PLAID

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Review ABSTRACTIncreased surveillance and heightened glucose control of pregnant women with diabetes in the United States has led to improved pregnancy outcomes. This heightened level of care often diminishes during the postpartum period and women may be left lacking knowledge and support for self-care following childbirth. The purpose of this article is to highlight topics from the literature that both patients and providers recognize as requiring further attention during the postpartum period for women with diabetes. Suggestions for addressing gaps in care are presented along with resources to improve patients' access to information and support.

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Original research: Postpartum testing rates among women with a history of gestational diabetes—Systematic review

Cited by 98 publications

References 67 publications

Postpartum Healthcare After Gestational Diabetes and Hypertension

Postpartum Healthcare After Gestational Diabetes and Hypertension

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Postpartum Care of Women Affected by Diabetes: A Review of Current Trends

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